Treatment options

Hormone Replacement Therapy

Hormone Replacement Therapy (HRT) is the most effective treatment for managing menopause symptoms. It works by replacing the hormones that naturally decline during the menopause transition, helping many women feel more like themselves again.

HRT is not a one-size-fits-all treatment. There are different types, doses, and ways of taking HRT, allowing treatment to be tailored to an individual’s needs and preferences.

HRT is available in a variety of forms, including:

Skin patches
Gels
Sprays
Tablets
Vaginal pessaries, creams, or gels for local symptoms

The choice of treatment depends on several factors, including medical history, lifestyle, personal preference, and individual treatment goals. Finding the right HRT regimen may take time, and some women may require adjustments to the type or dose of treatment to achieve the best results. Regular reviews help ensure treatment remains appropriate and effective throughout the menopause journey.

Non-Hormonal Treatments

While Hormone Replacement Therapy (HRT) is the most effective treatment for menopause symptoms, it may not be suitable or preferred by every woman. Several non-hormonal treatment options are available, particularly for the management of hot flushes and night sweats.

SSRIs
Selective Serotonin Reuptake Inhibitors (SSRIs) are a group of medications commonly used to treat depression and anxiety. Some SSRIs have also been shown to reduce menopausal hot flushes and may be considered for women who are unable to take HRT or who would prefer a non-hormonal treatment option. Examples of such drugs are fluoxetine, citalopram and sertraline.

SNRIs
Serotonin-Noradrenaline Reuptake Inhibitors (SNRIs) are another group of medications that can help manage menopausal symptoms, particularly hot flushes and night sweats. Like SSRIs, they were originally developed for mental health conditions but have been found to provide symptom relief for some menopausal women. Example o such a drug is venlafaxine.

Clonidine
Clonidine is a medication that has been used for many years to help reduce hot flushes. Although generally less effective than HRT, it may be a suitable option for some women who cannot take hormonal treatment and are looking for an alternative approach to symptom management.

Fezolinetant
Fezolinetant is a newer non-hormonal treatment developed specifically for menopause-related hot flushes and night sweats. Unlike other non-hormonal options, it was designed to target the underlying temperature regulation pathways in the brain that become disrupted during menopause. As it does not contain hormones, it may be an appropriate choice for women who cannot take HRT or who prefer a non-hormonal treatment option.

Testosterone Therapy

Although testosterone is often thought of as a male hormone, women naturally produce testosterone throughout their lives. Levels gradually decline with age and may decrease further during the menopause transition.

For some women, low testosterone levels may contribute to symptoms such as reduced sexual desire, diminished sexual satisfaction, low energy, and a loss of motivation or sense of wellbeing.

Testosterone therapy may be considered for menopausal women experiencing low sexual desire that is causing distress, particularly when symptoms have not improved with standard HRT alone. In the UK, testosterone is most commonly prescribed alongside HRT following an individual assessment.

As with all hormone treatments, testosterone therapy should be tailored to the individual, with regular monitoring to ensure treatment remains safe and effective.

Exercise and Nutrition

Menopause often brings changes in body composition, bone density, muscle mass, sleep and metabolism. A combination of exercises and nutrition can help manage mild to moderate symptoms and support long term health Impact of Exercise on Perimenopausal Syndrome: A Systematic Review of Randomized Controlled Trials – PMC

Lifestyle Changes

Changing lifestyle habits can also make a meaningful difference during menopause. Theses may include, smoking cessation advice, avoiding spicy foods, reducing or avoiding alcohol and maintaining a healthy BMI The role of lifestyle medicine in menopausal health: a review of non-pharmacologic interventions – PubMed